We carried out an inspection of Norley Hall Care Home on the 12, 13 and 14 September 2018, the first day of inspection was unannounced. The inspection was brought forwards due to a specific incident involving bed rails, which had occurred at the home on 30 August 2018 and is subject to a police investigation. In light of this incident we wanted to assess the quality and standard of care currently being provided to people living in the home. As a result of the ongoing investigation, we did not look in to the incident as part of this inspection. However, we did look at the system and process in place for bedrails to determine if there were any risks to other people living at the home.

Norley Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation and personal care for up to 52 older people, which is divided over two floors. At the time of inspection 49 people were living at the home.

The home was last inspected on the 20 and 28 October 2016, when it was rated as Good and was meeting all regulatory requirements. At this inspection we identified five breaches in four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, safeguarding people from abuse or improper treatment, staffing and good governance. We also made recommendations about capturing people and/or their relative’s involvement in care planning and reviews and reviewing the system used to determine staffing levels. You can see what action we asked the provider to take at the back of the full version of this report.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

Each person we spoke with told us they felt safe living at Norley Hall and had no concerns with the standard of care provided. Relatives were equally complimentary, stating their loved ones were being well looked after and cared for in a way they would like.

The home had appropriate safeguarding policies and reporting procedures in place and had submitted notifications to the local authority and CQC as required. However, whilst staff knew how to identify the different types of abuse and the procedure for reporting concerns, we found completion of safeguarding training was inconsistent and not regularly refreshed.

We found systems to ensure both the premises and equipment was safe and fit for purpose required strengthening, as not all required safety certificates and checks were in place or up to date. There was no annual schedule of when checks should be completed, which would minimise the risk of these being overlooked.

We saw medicines were stored, handled and administered safely. Staff responsible for administering medicines had been trained and had their competency assessed. However, we identified shortfalls in the maintaining of fridge temperatures, management of topical medicines and completion of daily audits.

Our observations found the home to be clean with detailed cleaning checklists and appropriate infection control processes in place. Staff had easy access to and wore personal protective equipment (PPE) to prevent the spread of infection.

Feedback received from people and their relatives indicated enough staff were on duty to safely meet people’s needs. Overall, staff also felt enough were deployed, though some suggested additional support at night would be useful, due to having to make and serve supper as well as support people to get ready for bed.

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Norley Hall Care Home is situated in its own grounds, on the outskirts of Wigan. The accommodation is divided over two floors. The service provides accommodation and personal care for up to 52 older people. At the time of our inspection there were 51 people living at the home. The service was last inspected in June 2014 when it was compliant with the regulations reviewed and in force at that time.

This was an unannounced inspection which took place on the 20 and 28 October 2016.

The service is required to have a registered manager in place. There was a registered manager in place at Norley Hall Care Home. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present during this inspection. People told us the registered manager was approachable and fair. During our inspection we found the registered manager to be open, caring and committed to providing a good quality caring service.

People told us they felt safe at Norley Hall Care Home. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

Robust recruitment procedures were in place which ensured staff had been safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

Medicines were stored safely and securely and procedures were in place to ensure people received medicines as prescribed.

Peoples support needs were assessed before they moved into Norley Hall Care Home. Care records were written in a person centred way and contained good information about people’s support needs, preferences and routines. Risk assessments were in place for people who used the service and staff. They described potential risks and the safeguards in place. Care records we had been reviewed regularly and had been updated when people’s support needs had changed. People and their relatives had been involved in planning and reviewing the care provided.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control.

We found the building to be clean, bright and well decorated with no malodours. The bedrooms we went in were spacious, well-furnished and were personalised with people's own photographs and ornaments.

Accidents and incidents were appropriately recorded. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

People had their health needs met and had access to a range of health care professionals. People at risk of poor nutrition and hydration had their needs regularly assessed and monitored. The food within the service was nutritionally balanced and plentiful. All the people we spoke with told us the food was good.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

All the people we spoke with were positive about the support they received and the caring and kind attitude of the staff. We found the atmosphere to be homely and interactions between staff and people who lived at the home were warm, friendly and relaxed. We found that the registered manager and staff we spo

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

During our inspection, we saw people who used the service were treated with dignity and respect. We spoke to several people and they told us they felt safe and their needs were met at the care home. A family member told us, "People are kept safe and well cared for."

Procedures were in place which helped ensure the provider and staff members learnt from any accidents or incidents. This minimised any possible risk to people who used the service and continually helped the quality of service to improve.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

People who used the service had their care needs assessed and their choices and preferences had been identified and recorded. All care was provided in accordance with the wishes of the person.

People who used the service and their families were invited to regular meetings and were also asked to complete surveys related to the quality of care being provided at the care home. Any identified shortfalls had been addressed.

Is the service caring?

We saw staff who were patient when providing care and support to people and showed a good understanding of how their needs should be met. We observed staff knocking on people`s doors before entering which showed respect for the person`s privacy.

We spoke to several people who used the service and one told us, "All the staff are lovely, they work so hard." Another person told us, "It`s absolutely champion here. No problems."

Is the service responsive?

The provider listened to the needs and wishes of people who used the service. People took part in a range of activities, both within the care home and around the local community. Neighbours from the surrounding area and pupils from local schools regularly attended events at the care home at the request of people who used the service.

People we spoke to knew how to make a complaint if they needed to. We looked at the last recorded complaint and saw it had been recorded and responded to appropriately in accordance with the provider`s policy.

Is the service well-led?

We saw that the provider worked well with other professional agencies, which included doctors and community nurses. On the day of our inspection, a community practitioner attended the care home. We were told, "He drops in regularly just to make sure everything is ok. If we ask him to see one of our residents, he does straight away."

Procedures were in place which helped ensure the quality of care provided to people who used the service continued to improve. Staff members we spoke to were clear about their roles and responsibilities.

During our inspection we spoke with six people living at Norley Hall Care Home and five visitors. People told us that they were happy living there and they thought that they were well looked after. One person told us “This home is better in every aspect that the last home where I was.” Another person said “I love it here here. I would not change anything.”

We found that people were cared for in clean, organised and well maintained environment that was free from unpleasant odours. We looked at staffing rotas and we found that there were sufficient numbers of suitably qualified qualified, skilled and experienced staff to meet people’s needs.

We checked people’s records and found that they were kept in appropriate places and that they were accurate and up to date.

We saw that there were appropriate systems in place to monitor the quality of care that people received the home and that the manager responded to comments and suggestions made by people, their relatives and members of staff.

People told us that they were happy living at Norley Hall Care Home. People told us “This is an excellent home”, “The staff are very good” and “You can go to your room whenever you want to.”

We spoke with three people who were visiting their relatives. We were told “They (staff) do care about people who live here”, “Staff are kind courteous and helpful. We looked at a lot of homes but this was the best one” and “We have no complaints at all about this home.”

We did not receive any negative feedback about the home. The people who we spoke with told us that they liked the home and would not change anything about it.

People who lived at Norley Hall told us that they liked living there.

They said that they were well looked after:

‘It’s very nice, very comfy…I’ve been seen by the doctor, they treat me well.’

People said that they liked the food:

‘’It’s very nice-up to now it hasn’t been bad- she has an idea of what suits.’

‘I like everything but if I didn’t like it they would give me something else.’

And

‘Food is very good- we get a very nice breakfast, tea, dinner….there’s no shortage.’

People said that the home organised enough activities to keep them stimulated.

Comments included:

‘We have lots of entertainment.’

And

‘Activities are brilliant, everybody is involved.’

People living at Norley Hall liked the staff and felt safe.

They told us:

‘The staff are excellent A1, you couldn’t get nicer.’

‘The staff are lovely, not been here long and everything is fine he’s settled in well.’

People living at Norley Hall were content.

‘You couldn’t say anything was wrong with it at all.

Staff we talked to were positive about working at the home and the way it was run.

The told us:

‘The manager and deputy are very approachable, they will listen to you if there is a problem.’

And

‘The owner is very generous- if we need anything he will consider it.’

And

‘Staff morale is – I would say- excellent.’

We talked to service users, visitors, students, staff and a visiting health professional during the visit to Norley Hall and only positive comments were made about the standard of support provided.